Introduction Communication skills are notoriously hard to teach and describe. There are too many possible situations that one might encounter to be able to draw rules or guidelines. In addition, your actions will depend greatly on the personalities present—not least of all your own! Using this chapter Over the following pages, there is some general advice about communicating in different situations and to different people. We have not provided rules to stick to, but rather tried to give the reader an appreciation of the great many ways the same situation may be tackled. Ultimately, skill at communication comes from practice and a large amount of common sense. A huge amount has been written about communication skills in medicine. Most is a mix of accepted protocols and personal opinion—this chapter is no different. The rule is: there are no rules. Communication models There are many models of the doctor-patient encounter which have been argued over at great length for years. These are for the hardened students of communication only. We mention them only so that the reader is aware of their existence. Patient-centred communication In recent years, there has been a significant change in the way healthcare workers interact with patients. The biomedical model has fallen out of favour. Instead, there is an appreciation that the patient has a unique experience of the illness involving the social, psychological, and behavioural effects of the disease. The ‘biomedical’ model Doctor is in charge of the consultation. Focus is on disease management. The patient-centred model Power and decision-making is shared. Address and treat the whole patient. P.3 Box 1.1 Key points in the patient-centred model Explore the disease and the patient's experience of it: Understand the patient's ideas and feelings about the illness. Appreciate the impact on the patient's quality of life and psychosocial well-being. Understand the patient's expectations of the consultation. Understand the whole person: Family. Social environment. Beliefs. Find common ground on management. Establish the doctor-patient relationship. Be realistic: Priorities for treatment. Resources. Box 1.2 Confidentiality As a doctor, health care worker or student, you are party to personal and confidential information. There are certain rules that you should abide by and times when confidentiality must or should be broken ( p.32). The essence for day-to-day practice is: Never tell anyone about a patient unless it is directly related to their care. This includes relatives and can be very difficult at times, particularly if a relative asks you directly about something confidential. You can reinforce the importance of confidentiality to relatives and visitors. If asked by a relative to speak to them about a patient, it is a good idea to approach the patient and ask their permission, within full view of the relative. This rule also applies to friends outside of medicine. As doctors and others, we come across many amazing, bizarre, amusing, or uplifting stories on a day-to-day basis but, like any other kind of information, these should not be shared with anyone. If you do intend to use an anecdote for some after-dinner entertainment, at the very least, you should ensure that there is nothing in your story that could possibly lead to the identification of the person involved. P.4 Essential considerations Attitudes Patients are entrusting their health and personal information to you—they want someone who is confident, friendly, competent, and above all, is trustworthy. Personal appearance First impressions count—and studies have consistently shown that your appearance (clothes, hair, make-up) has a great impact on the patients' opinion of you and their willingness to interact with you. Part of that intangible ‘professionalism’ comes from your image. The white-coat is still part of medical culture although sadly appears to be dying out in the UK at this time. Fashions in clothing change rapidly but some basic rules still apply. Neutralize any extreme tastes in fashion that you may have. Men should usually wear a shirt and tie. Women may wear skirts or trousers but the length of the skirts should not raise any eyebrows. The belly should be covered—even during the summer!
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